Continuing education and competency: some critical unresolved issues

There are numerous dilemmas and contradictory philosophies that the health professions face in planning programs and goals for continuing education and competency. Among the issues that are discussed are: (1) whether learning should be based on prescriptive or felt needs; (2) whether the ultimate objectives should be toward fostering practitioner safety or competence; and (3) whether the focus of assessment should be at the entry or advanced level. The discussion points out that continuing education does not, by its mere presence, assure continuing competency, and several suggestions are offered. First, there is no satisfactory definition of clinical competence to use in structuring program objectives or assessing their attainment. For example, if incompetence is considered to be the manifestation of patient harm, how serious must the harm be and how many patients must be harmed? This is an extremely difficult and complex issue, but one that must be faced. Second, the consuming public should be better informed and educated in identifying marginal practitioners. This is seen as an important, although currently lacking, component of voluntary approaches to continuing competency. Finally, reference is made to the potential of criterion-referenced testing for defining acceptable skill thresholds.